Hepatobiliary and pancreatic: Herniation of the liver
Bibliographic record
Abstract
A 48-year-old woman was investigated because of a 3-week history of discomfort and swelling in the epigastrium. Two years previously, she had coronary artery bypass surgery that was complicated by a post-operative sternal dehiscence. On physical examination, she had a lump in the epigastrium with minimal tenderness on palpation. Screening blood tests were within the reference range. Images from a computed tomography (CT) scan of the abdomen are shown in 1, 2. In Figure 1, an axial image shows herniation of a segment of the left lobe of the liver through a midline defect in the anterior abdominal wall. A similar abnormality was shown on the parasagittal reconstructed image in Figure 2. In the axial image, the appearance resembles the face of a horse with the herniated segment representing an ear while the reconstructed image resembles a duck swimming on a pool of intra-abdominal fat. Thus far, the patient has been observed without surgery as symptoms are relatively minor and there is no persuasive evidence of incarceration or other complications. Herniation of the liver into a surrounding structure is a rare phenomenon. Most case reports have been associated with either congenital diaphragmatic hernias or diaphragmatic hernias that develop after chest trauma. Although traumatic hernias mostly involve the left diaphragm, tears in the right diaphragm can occur because of rib fractures or compression injuries. Occasionally, chronic diaphragmatic hernias need to be differentiated from elevation of the dome of the diaphragm (eventration) that may follow disorders such as phrenic nerve palsy. Thus far, there have only been 2 previous cases where the liver has herniated through the anterior abdominal wall. One patient had an incisional hernia while the second patient had herniation of the liver into the rectus muscle. Most of these hernias can be satisfactorily demonstrated with a CT scan. Chronic diaphragmatic hernias that contain liver are usually symptomatic with either pain or respiratory symptoms and require surgical repair. One of the 2 reports of anterior abdominal herniation was associated with incarceration and was also treated surgically. However, if symptoms are minor, observation without surgery can be an option as illustrated by this and other cases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".